MEDICARE: JUSTIN TODD MARTIN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0009636	OR
2	1835P1200X	Pharmacotherapy Pharmacist	9636	OR

General Provider Information

NPI Number	:	1699790659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TODD MARTIN PHARMD

Provider Business Mailing Address
First Line	:	2875 NE STUCKI AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5806
Country	:	US
Telephone Number	:	971-310-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 NE STUCKI AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5806
Country	:	US
Telephone Number	:	971-310-4050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/22/2025

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